Diagnosis of secondary caries is inconsistent between dental practitioners, and
often not based on objective criteria.6–9 If in doubt, most general dental practitioners
adopt a “defensive dentistry” approach by choosing replacement as opposed to one
of the range of minimal intervention options, including systematic monitoring of
such restorations, ie, if in doubt, wait and watch rather than take it out. Decisions
to replace restorations with limited defects are particularly common for restorationsnot placed by the evaluating practitioner,10 as demonstrated
in analyses of the patterns of provision of dental restora-
tions within National Health Service dental services in the
UK and in large North American studies.11,12 For example,
within a cohort of over 300,000 patients in 2002, Bogacki
et al noted that the probability of survival of both posterior
amalgam and resin composite restorations was in excess
of 90% over 5 years, but that this survival rate dropped to
60% (for both types of restoration) when patients changed
dentist.12 A more recent dental practice-based research study,
involving 197 clinicians in the USA and Scandinavian coun-
tries, and close to 10,000 restorations, indicated that when
considering treatment options for restorations with local-
ized defects, in over 75% of cases the practitioners choose
replacement rather than repair.13 The same study confirmed
that decisions to replace restorations with limited defects
are particularly common for restorations not placed by the
evaluating practitioner.